Killer Lemonade

Everyone enjoys a nice cold glass of lemonade in the summers, especially with our heat lately. Recently, a friend of mine went through a local fast food drive thru and ordered sugar free lemonade. She is diabetic and is very careful with her daily sugar intake to keep her glucose levels in check. She took 2 sips and knew it was a little too sweet. So she pulled out her tester to see what the sugar level was and it read over 400! Had she assumed it was just a really good tasting sugar free drink, she was have ended up in a coma! So when she spoke with the restaurant manager they couldn't understand why she was so upset. Their offer for a free replacement they thought should have been enough. She tried to explain the problem and got "I don't understand what the problem is"!!!!!

Really???!!

So if you are reading this and you don't understand the problem, let me fill you in. If you are diabetic, sugar is not your friend! Especially excess amounts. Your body does not have a good way of processing that sugar. And excess sugar in the system causes harm to all vital organs. When that sugar gets to a certain high level, you can become groggy, light headed, feel faint and possibly end up in a coma or worse.

Now, let's say you don't end up in a coma, but you thoroughly enjoy that lemonade and you happen to have an open sore on your foot. Well, bacteria love sugar so basically you just gave them a meal of a lifetime! This causes more bacteria to grow leading to infection that could lead to a hospital stay, surgery or even amputation.

Wow! All that from a simple lemonade! Well, lesson here is to always ask for diet. And if you aren't sure about it, return and just get water. At least with water, you never have to worry about the sugar or calorie content!

Don't Step on That!!

It's 104 degrees in the shade in Dallas Texas these days. That makes our surrounding surfaces quite hot. In fact, it's about time for one of our local news crews to cook an egg on the sidewalk. So if it's hot enough to make a "smothered and covered" on the sidewalk, then you have absolutely no need to walk barefoot to check the mail if you are diabetic (and even if you aren't).

When diabetic patients lose the feeling in their feet, they often think it is ok to walk around barefoot. "It's ok, I can't feel it anyway". That's not the case. I will see time and again in the summers, diabetic patients who walk barefoot on sidewalks or concrete for just a few steps that cause 3 degree burns to those precious feet.

Now as I've discussed in previous blogs, any open wound can cause infection that leads to amputation. Burns are among the worst. Most of the time they do get infected. And if they are extensive, meaning covering the majority of the foot, that is high alert for amputation. And I'm not talking taking off a toe or two, the whole leg. Just for walking barefoot.

If this does happen to you, seek treatment immediately. The wounds need to be cleansed properly and antibiotics started right away. And a good wound care regimen is necessary to heal those wounds.

Be smart when it's hot. Wear your shoes!

Diabetic Patients Need All We Can Give

It cannot be said enough, that everything that can be done must be done to prevent a diabetic patient from losing a limb. Here are some of the techniques that FAANT uses in this battle.

1. Vascular testing
With this exam, we are testing the blood flow status of the lower extremities, or the "plumbing" part of the legs. This non painful test applies pressure cuffs at different intervals to the feet and legs and gives us a picture of the amount of blood making its way to the toes. This study should be performed every one to two years to catch changes in blood flow that can occur in diabetic patients and enables us to treat this change aggressively. A dramatic loss in blood flow to the feet can lead to amputation.

2. Xray exams
Plain ol' xrays can play a significant role in protecting those diabetic feet. We are looking for changes like severe arthritis, breakdown of joints, infection, bone spurs and anything that can put your feet in jeopardy that can't be seen outside the skin.

3. Neurologic exam
Three things can be tested easily in the office: Light touch, vibration and proprioception (big word for you know where you are in space). Testing for these 3 things will give us a basic idea of what you feel and what you don't feel. And guess what...80% of the time, you don't feel what you think you do.

4. Bio-engineered tissue and grafts
When there is an ulcer, technology has given us the ability to get it healed quickly with bio-engineered tissue like Apligraf, Dermagraft and Theraskin. These products, when placed on a healthy wound, reduce the healing time dramatically.

5. Shoes, boots and stuff
To keep those feet healthy, we will often prescribe diabetic shoes with protective inserts to reduce pressure and possibility of ulcers. At times, it might be necessary to use walking boots, total contact casts, post op shoes and offloading pads to reduce pressure and save those feet.

6. Good old fashion exam
Actually examing your feet for signs of change or worsening. This is our single best tool. When we see things change, we must act to prevent further change that can lead to amputation. If a new callus pops up, we must stop it from ever forming again. Sometimes this is impossible, but there are so many things that can be done to keep that callus from becoming an ulcer. And don't think that those bunions and hammertoes goes unnoticed. They must be watched on a regular basis and sometimes surgically corrected to save those tootsies.

As we continue to strive to save more and more lower extremities, all of these things are nothing if you as a diabetic patient do not do your part. You must maintain control of your blood sugar, take your mediations as prescribed and check your feet every single day.

New Guidelines for Exercise in Type 2 Diabetes

New guidelines were published in late 2010 that stress the crucial role that physical activity plays in the management of Type 2 diabetes. Exercise is important and you should not let foot pain slow down your exercise program. The physicians at Foot and Ankle Associates of North Texas, in Grapevine, Texas, encourage our diabetics to exercise and can help you reach your goals with better shoe gear, functional foot orthotics and even physical therapy to get you on the road to better diabetes control! Do not use foot pain as an excuse not to exercise, contact us and get started today! The guideline are crystal clear on the importance of regular, vigorous exercise!

Developed by a panel of 9 experts, the new guidelines are published concurrently in the December issue of Medicine & Science in Sports & Exercise and Diabetes Care.

"High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently," the expert panel writes, "but it is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay Type 2 diabetes mellitus, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life."

Most of the benefits of exercise are realized through acute and long-term improvements in insulin action, accomplished with both aerobic and resistance training, the experts write.

For people who already have Type 2 diabetes, the new guidelines recommend at least 150 minutes per week of moderate to vigorous aerobic exercise spread out at least 3 days during the week, with no more than 2 consecutive days between bouts of aerobic activity. These recommendations take into account the needs of those whose diabetes may limit vigorous exercise.

Sheri R. Colberg, PhD, writing chair, professor of exercise science at Old Dominion University, adjunct professor of internal medicine at Eastern Virginia Medical School, Norfolk, Virginia, and regular Diabetes In Control contributor, stated that, "Most people with Type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopedic or other health limitations." "For this reason, the ADA [American Diabetes Association] and ACSM [American College of Sports Medicine] call for a regimen of moderate-to-vigorous activity and make no recommendation for a lesser amount of vigorous activity."

The panel specifically recommends that such moderate exercise correspond to approximately 40% to 60% of maximal aerobic capacity and states that for most people with Type 2 diabetes, brisk walking is a moderate-intensity exercise.

The expert panel also recommends that resistance training be part of the exercise regimen. This should be done at least twice a week -- ideally 3 times a week -- on nonconsecutive days. The panel also recommends that people just beginning to do weight training be supervised by a qualified exercise trainer "to ensure optimal benefits to blood glucose control, blood pressure, lipids, and cardiovascular risk and to minimize injury risk."

Regular use of a pedometer is also encouraged. In a meta-analysis of 8 randomized controlled trials and 18 observational studies, people who used pedometers increased their physical activity by 27% over baseline. Having a goal, such as taking 10,000 steps per day, was an important predictor of increased physical activity, according to the expert panel.

Finally, the new guidelines emphasize that exercise must be done regularly to have continued benefits and should include regular training of varying types.

Physicians should prescribe exercise, Dr. Colberg said in a statement. "Many physicians appear unwilling or cautious about prescribing exercise to individuals with Type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with Type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity."

The physicians at Foot and Ankle Associates of North Texas encourage our diabetics to exercise and can help you reach your goals with better shoe gear, functional foot orthotics and even physical therapy to get you on the road to better diabetes control! Do not use foot pain as an excuse not to exercise, contact us and get started today!

Oh Those Sugary Treats

It's the holiday season and the smell of amazing baked goods, candies and treats fills the air. So what is the harm in having just one of these treats if you are diabetic? Well, let's take 2 diabetic people and see what these treats can do.

"Janie" has had diabetes for 20 years. She checks her blood sugar daily and takes her medications as instructed. She is careful about the amount of carbohydrates and sugars she eats daily and exercises regularly. So for Christmas dinner, she indulges with a small piece pecan pie. She also drinks plenty of water. That evening she checks and her sugar is slightly higher, but returns to her normal routine the next day without the sugar treats. All is good for Janie.

"Robert" was recently diagnosed with diabetes 1 year ago and still refuses to check his sugar daily because he doesn't like to stick his finger with that needle. In fact, he hasn't checked it in 4 months. He takes his medications, most of the time. As he says, "I get busy and sometimes forget". He thought about exercising a year ago, but just hasn't found the time to fit it into his schedule. When he saw his doctor 6 months ago, he was urged to take better care of himself so he switched from regular Coke to Coke Zero. From Thanksgiving to Christmas, he enjoys all the wonderful breads, cakes and munchies homemade by his friends and family...all full of sugar and carbohydrates. Christmas night he becomes dizzy and confused and his family calls 911 after he becomes unconscious. He spends the next week in ICU at the hospital in a diabetic coma with sugars over 800.

So, it is obvious that Janie is in better control and much more attuned to what she can and cannot eat. Robert on the other hand knew he shouldn't eat the "sweet" treats, but did it anyway. But didn't realize the breads and other food full of carbohydrates like potatoes and pasta does the same thing to his body as the sugary stuff.

Educating yourself about what foods do to you as a diabetic is so important in preventing what Robert went through. But realizing you cannot bury your head in the sand and it will all go away is the most important. Take control of your diabetes. Check your sugars daily so you can actually see what that pasta meal does. Take your medications as prescribed. If you have questions, ask your doctors. Become a member of the American Diabetes Association which is a vast amount of resources to help you gain control.

Enjoy the holiday season and don't let those sugary treats tempt you! It's not worth it!

The Journey to a Texas Ironman

Off days…love them! It is the one time I can catch up on reading and a bunch of other items on the to-do list. Recently, I tripped across an article in the New York times referencing how 40 somethings are turning to triathlons. Leave it to someone to come up with this acronym: Mamils. Mamils stands for Middle Aged Men In Lycra. So if the over 40 male crowd is a Mamil, then I guess you can lump Dr. Crane and I in the Mafil category.

I’ll take it. I think Mafil is pretty cool. Here we are living a healthy lifestyle, dedicated to the sport, with the occasional luck of placing in the top three of either age or weight division and enticing people everyday to become more active and live healthier lifestyles. Many of our friends think we are nuts. I’ll take that as well. I think you do have to be nuts to a certain extent to plan out and execute daily workouts on top of work and all the other curve balls this thing called life pitches to us.

As I read the article, it mentioned the median age group is 41 years of age. I would agree with that. The average salary however which was listed at 175,000 may be a bit grand. You see, there are many who do not necessarily fall for the paying full price on the latest gear. I am one of them. I cannot remember the last time I paid full price for anything except for race entries and the bike jersey from each race. Thanks to the internet, and social websites, you can learn a lot from clothing to bikes to running shoes. Many people I meet are do not necessarily have the best of the best however they often are the winners of their respective age group. Sure, the pros have the latest and greatest…then again it sure helps to be sponsored by the brands plastered all over their clothing, helmet, shoes, bike, wetsuit, running shoes…well, you get the picture.

It all boils down to the athlete. You need to train and put time into all three disciplines. You also need to eat right, maintain life balance and sleep. Sure, I do adore my bike and the few upgrades I have done (discounted items of course) but the bike isn’t going to obtain the level of endurance needed for the IronMan. It comes down to training. So for those who think they must be of a certain income level to be in triathlons whether long or short distance your wrong. You can join in on the great fun of the multisport lifestyle just like the next guy……but you do need to train.

Talk to ya next week,
Janet

Why Do Diabetics Lose Their Legs?

You have had problems with your foot for years. Your doctor now tells you that the foot needs to be amputated. How did this happen? Do you have to go through with the surgery? What will happen if you keep your foot?

Diabetes is a devastating disease. It can be managed, and many of the complications of diabetes are preventable. This takes much dedication of the patient and a team of doctors. Discovering you have diabetes and making life changes to prevent life threatening complication of the disease is very difficult. Thus, many people still run into problems associated to diabetes. Foot problems are among one the most common complications. 70% of all limb amputations are due to diabetes!

There are several reasons diabetics have foot problems but let’s talk about the three big causes. When the nerves are exposed to high levels of glucose or high blood sugars, they are slowly damaged. Thus, many diabetics suffer from peripheral neuropathy, a disease in which they slowly lose protective sensation in the feet. This can be very dangerous. I have had patients who had glass, needles, tacks and other objects stuck in their foot and they never remember how it happened. I have also had patients burn themselves in the bath tub. Their feet can no longer perceive temperature and they can easily burn or freeze their feet!

Diabetics also suffer from poor circulation. Blood carries many nutrients and oxygen that is essential to keep tissues healthy. Poor blood supply makes it extremely difficult for damaged tissues to heal. When a patient has a wound or ulcer on the foot, their poor blood supply makes it is so hard for the area to heal. Diabetics also have a compromised immune system. The body is weakened in its defense mechanism to fight off infections. Infections kill good tissues and leaves dead necrotic tissue behind. Infections can spread very fast from soft tissue to bone and joints and even into the blood supply. Infections can be life threatening.

When the threat of infection is too severe and can no longer be managed by antibiotics, the doctor may suggest an amputation. To remove all or as much dead tissue as possible helps prevent the infection spreading to other areas of the body. A doctor may also suggest amputation if the foot has become non-functional.

The thought of losing a part of your body is a very difficult concept to deal with. It is not uncommon for the doctor to suggest therapy to help the patient cope with process of surgery and rehabilitation. It is important to note that amputations are a part of medical plan to keep you as health as possible. It is important to discuss your fears and concerns with your doctor and to seek second opinions if you do not feel comfortable with your doctor’s advice. It is your leg and should be fully aware to the risk and consequences of keeping and amputating portions of your limb.